February 12, 1997 - Introduced by Representatives Carpenter, Bock, R. Potter,
Cullen, Hasenohrl, Gronemus, Musser, R. Young, Turner, Baldwin,
Morris-Tatum, Notestein, Kreuser and Wasserman, cosponsored by
Senators Clausing, Burke, Wirch and
Rosenzweig. Referred to Committee on
Consumer Affairs.
AB76,1,4
1An Act to amend 40.51 (8), 40.51 (8m), 60.23 (25), 66.184, 120.13 (2) (g), 185.981
2(4t) and 185.983 (1) (intro.); and
to create 111.91 (2) (n), 609.86 and 632.895
3(11) of the statutes;
relating to: requiring insurance coverage of preventive
4pediatric health care services.
Analysis by the Legislative Reference Bureau
This bill requires every health insurance policy (called "disability insurance
policy" in the statutes), including health care plans offered by health maintenance
organizations, preferred provider plans and the state, and every self-insured health
plan of the state or a county, city, town, village or school district, to provide coverage
of preventive pediatric health care services, from birth to age 19, for a dependent
child of the insured if the policy or plan covers a dependent. (Under current law,
health insurance policies are required to cover a newly born child of the insured, even
if the policy did not provide coverage for dependents at the time of the birth.) Under
the bill, preventive pediatric health care services include specified immunizations
and other services that are in accord with the prevailing medical standards of the
American Academy of Pediatrics, such as developmental assessments, sensory
screening, laboratory tests and initial dental referrals. Coverage of preventive
pediatric health care services may not be subject to any deductibles, coinsurance or
copayments. Specifically excluded from this coverage requirement are health
insurance policies that cover only certain specified diseases, health care plans
offered by limited service health organizations, medicare replacement or
supplement policies and long-term care insurance policies.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB76,2,53
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
4shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.745 (1) to (3) and (5),
5632.747, 632.87 (3) to (5), 632.895 (5m) and (8) to
(10) (11) and 632.896.
AB76,2,108
40.51
(8m) Every health care coverage plan offered by the group insurance
9board under sub. (7) shall comply with ss. 632.745 (1) to (3) and (5)
and, 632.747
and
10632.895 (11).
AB76,2,1613
60.23
(25) Self-insured health plans. Provide health care benefits to its
14officers and employes on a self-insured basis if the self-insured plan complies with
15ss. 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3),
16632.87 (4) and (5), 632.895 (9)
and (11) and 632.896.
AB76,3,3
1966.184 Self-insured health plans. If a city, including a 1st class city, or a
20village provides health care benefits under its home rule power, or if a town provides
21health care benefits, to its officers and employes on a self-insured basis, the
1self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
2632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9)
and
3(10) to (11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).
AB76, s. 5
4Section
5. 111.91 (2) (n) of the statutes is created to read:
AB76,3,65
111.91
(2) (n) The provision to employes of the health insurance coverage
6required under s. 632.895 (11).
AB76,3,129
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
1049.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2.,
11632.747 (3), 632.87 (4) and (5), 632.895 (9)
and (10)
to (11), 632.896, 767.25 (4m) (d)
12and 767.51 (3m) (d).
AB76,3,1715
185.981
(4t) A sickness care plan operated by a cooperative association is
16subject to ss. 252.14, 631.89, 632.72 (2), 632.745, 632.747, 632.749, 632.87 (2m), (3),
17(4) and (5), 632.895 (10)
and (11) and 632.897 (10) and ch. 155.
AB76,3,2520
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
21exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
22601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
23(2), 632.745, 632.747, 632.749, 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5),
24632.895 (5)
, (9) and (10) and (9) to (11), 632.896 and 632.897 (10), subch. II of ch. 619
25and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:
AB76, s. 9
1Section
9. 609.86 of the statutes is created to read:
AB76,4,4
2609.86 Coverage of preventive pediatric health care services. Health
3maintenance organizations and preferred provider plans are subject to s. 632.895
4(11).
AB76, s. 10
5Section
10. 632.895 (11) of the statutes is created to read:
AB76,4,76
632.895
(11) Preventive pediatric health care services. (a) In this
7subsection:
AB76,4,108
1. "Appropriate and necessary immunizations" means the administration of
9vaccine that meets the standards approved by the U.S. public health service for such
10biological products against at least all of the following:
AB76,4,1111
a. Diphtheria.
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b. Pertussis.
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h. Haemophilus influenza B.
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i. Hepatitis B.
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j. Any other disease for which immunization is recommended by the American
21Academy of Pediatrics.
AB76,4,2222
2. "Dependent" has the meaning given in s. 635.02 (3c).
AB76,5,223
3. "Preventive pediatric health care services" includes appropriate and
24necessary immunizations and such other services that are in accord with the
25prevailing medical standards of the American Academy of Pediatrics as physical
1examinations, developmental assessments, sensory screening, anticipatory
2guidance, initial dental referral and appropriate laboratory tests.
AB76,5,73
(b) Except as provided in par. (d), every disability insurance policy, and every
4self-insured health plan of the state or a county, city, town, village or school district,
5that provides coverage for a dependent of the insured shall provide coverage of
6preventive pediatric health care services, from birth to the age of 19 years, for a
7dependent who is a child of the insured.
AB76,5,98
(c) The coverage required under par. (b) may not be subject to any deductibles,
9copayments or coinsurance.
AB76,5,1010
(d) This subsection does not apply to any of the following:
AB76,5,1111
1. A disability insurance policy that covers only certain specified diseases.
AB76,5,1312
2. A health care plan offered by a limited service health organization, as defined
13in s. 609.01 (3).
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3. A long-term care insurance policy, as defined in s. 600.03 (28g).
AB76,5,1515
4. A medicare replacement policy, as defined in s. 600.03 (28p).
AB76,5,1616
5. A medicare supplement policy, as defined in s. 600.03 (28r).
AB76,5,1818
(1) This act first applies to all of the following:
AB76,5,2119
(a) Except as provided in paragraphs (b) and (c
), disability insurance policies
20that are issued or renewed, and self-insured health plans that are established,
21extended, modified or renewed, on the effective date of this paragraph.
AB76,5,2422
(b) Disability insurance policies covering employes who are affected by a
23collective bargaining agreement containing provisions inconsistent with this act
24that are issued or renewed on the earlier of the following:
AB76,5,25
251. The day on which the collective bargaining agreement expires.
AB76,6,2
12. The day on which the collective bargaining agreement is extended, modified
2or renewed.
AB76,6,53
(c) Self-insured health plans covering employes who are affected by a collective
4bargaining agreement containing provisions inconsistent with this act that are
5established, extended, modified or renewed on the earlier of the following:
AB76,6,6
61. The day on which the collective bargaining agreement expires.
AB76,6,8
72. The day on which the collective bargaining agreement is extended, modified
8or renewed.
AB76,6,1110
(1)
This act takes effect on the first day of the 5th month beginning after
11publication.
